Bile is a greenish-yellow fluid that is secreted from the duodenum, which is the first part of the small intestine. The duodenum is connected to the end of the stomach so under normal conditions bile should not enter the stomach. However, in a condition known as bile reflux it may enter the stomach and even reach up as high as the esophagus (food pipe), throat and even the mouth.
Normally bile is produced by the liver and then stored in the gallbladder. When we eat fatty foods, bile is then released from the gallbladder into the duodenum. This helps to emulsify fats and make it easier to digest. At the same time the liver is able to get rid of wastes as the bile passes out with stool. Therefore bile should travel from the duodenum down to the rectum and never flow backwards up into the stomach.
How does bile enter the stomach?
Movement of food and fluids into and out of the stomach is controlled by two valves. One valve at through which food enters the stomach from the esophagus is the lower esophageal sphincter (LES). The other valve through which food passes out of the stomach and into the duodenum (small intestine) is known as the pyloric sphincter.
These are one-way valves. This means that under normal circumstances the lower esophageal sphincter (LES) will prevent the stomach contents from passing upward into the esophagus. Similarly the pyloric sphincter should not allow food and fluids in the duodenum from entering the stomach. However, when these valves malfunction then this backward flow cannot be prevented.
Bile can therefore enter the stomach if the pyloric valve is not functioning properly. This does occur during severe and forceful vomiting even though the pyloric valve is otherwise healthy. However, in some people the valve is weakened and bile reflux can become a chronic problem. The bile may pass beyond the stomach and together with stomach acid and enzymes, it may reach the esophagus and beyond.
Read more on bile reflux.
Causes of Bile in the Stomach
Bile reflux is not a common condition like gastroesophageal reflux (GERD) whereby stomach acid enters the esophagus (also known as acid reflux). In fact GERD is one of the most common upper gastrointestinal conditions across the globe. It affects infants, children and adults. Bile reflux on the other hand is mainly seen in adults with one or more of the following causative factors.
This is one of the main causes of bile reflux. People who have undergone surgery to remove the stomach like with stomach cancer or bypass it as part of a weight loss treatment are more likely to suffer with bile reflux.
Bile reflux is also frequently seen in people who have undergone a cholecystectomy. This is a surgery whereby the gallbladder is removed and frequently done these days as a treatment for gallstones.
Another conditions which can lead to bile reflux is peptic ulcer disease. These ulcers can prevent the stomach from emptying properly and leads to a build up of pressure in the stomach. Bile can then seep into the stomach.
Signs and Symptoms
The signs and symptoms of bile reflux are largely the same as acid reflux. In fact both conditions often occur simultaneously. These signs and symptoms include:
- Heartburn – usually occurs as episodes where there is a burning chest pain.
- Abdominal pain – dull gnawing ache in the upper abdomen.
- Nausea – due to irritation of the stomach and esophagus.
- Vomiting – the bright yellow-green vomitus is most likely due to bile.
- Sore throat – the reflux may reach the throat and cause a burning sensation.
- Cough – irritation of the throat can cause a cough.
- Hoarse voice – reflux can enter the larynx and affect the vocal cords.
Unintentional weight loss may also occur with bile reflux. However, this weight loss needs to be carefully investigated as along with some of the symptoms mentioned above it may be an indicator of stomach cancer.
Furthermore, the symptoms of a heart attack can closely mimic that of acid reflux. Therefore acid or bile reflux needs to be diagnosed bye a medical professional. Beware of symptoms like dizziness, shortness of breath, excessive sweating and arm pain with heartburn as this could be due to a heart attack.
Treatment of Bile in the Stomach
Drugs used for the treatment of acid reflux and gallstones may both be used to manage bile reflux. These drugs include:
- Acid-suppressing drugs like proton pump inhibitors (PPIs) which inhibit stomach acid production.
- Bile agents like ursodeoxycholic acid which promotes bile flow and bile acid sequestrants which disrupt the circulation of bile.
When symptoms are severe and/or persistent then surgery may be necessary. These procedures include:
- Roux-en-Y, also known as diversion surgery, where bile drainage is rerouted to lower down the small intestine to prevent reflux into the stomach.
- Fundoplication, also known as anti-reflux surgery, where the lower esophageal sphincter (LES) is strengthened to prevent acid reflux.
In severe and untreated cases, the bile reflux can lead to complications such as:
- Barrett’s esophagus where there is a change in the esophageal tissue as a result of long term exposure to stomach acid. This tissue can become cancerous.
- Cancer of the esophagus may occur with repeated bile reflux or acid reflux as the esophagus tissue is repeatedly damaged and this can give rise to cancerous cells.
Diet and Prevention
Bile reflux does not respond to dietary changes and other preventative lifestyle changes as does acid reflux. However, these dietary and lifestyle changes may still be helpful since acid reflux tends to occur very often with bile reflux.
Read more on acid reflux diet.
Apart from these dietary changes, the following measures may also be useful in minimizing the severity of bile reflux:
- Eat many small meals rather than a few large meals.
- Do not lie down or sleep immediately after meals.
- Minimize alcohol intake or avoid it altogether.
- Raise the head of the bed so that gravity can help reduce backward flow.
- Try to maintain a healthy weight as acid reflux is worse in people who are overweight or obese.